Expectant management of placenta previa: cost-benefit analysis of outpatient treatment

Abstract

Objective: In this study outpatient and inpatient expectant management for complete placenta previa were compared in terms of maternal and neonatal outcome and overall cost.

Study design: We reviewed the outcomes and hospital costs of 72 mother-infant pairs where the pregnancy was complicated by second- or third-trimester placenta previa and was managed expectantly either with hospitalization or outpatient bed rest. The data were analyzed with the two-sided unpaired t test, chi 2, and simple correlation analysis.

Results: There were no differences in maternal morbidity as measured by estimated total blood loss, number of blood transfusions, nadir hematocrit, or need for emergency delivery. Fetal mortality was comparable in both groups, and there were no significant differences in neonatal morbidity as measured by gestational age, birth weight, 5-minute Apgar score, or occurrence of fetal distress. Among outpatients the number of maternal hospital days was reduced by 50% (p < 0.01). Outpatient management achieved a hospital cost reduction of 48.5% for mothers (p < 0.001) and 39.4% for mother-infant pairs (p < 0.05).

Conclusion: In selected patients outpatient management of complete placenta previa can be cost-effective and safe.